Disraeli's comments regarding statistics are especially pertinent regarding prostate cancer diagnosis. (Photos.com)
There’s another way to look at the reduction in the number of deaths. In the study, 162,000 men were followed for 10 years. Of those given the PSA test, 261 died, compared to 363 deaths of those who received routine care. A difference of 102 deaths out of 162,000 men isn’t as impressive.
Another statistic helps patients decide about the value of the PSA test. To prevent one prostate cancer death, 1,410 men have to be screened by the PSA test and an additional 48 men treated. This means that a massive screening program would have only a modest effect on mortality, and some men would get treatment and complications they didn’t need.
So statistics can be misleading, or as another wise sage said, “Statistics can be used as drunken men use lampposts—for support rather than for illumination.”
Two. How many angels can dance on the head of a pin? I don’t know the answer to this question. Nor do I, or others, know what is the best treatment for prostate cancer. One would need the wisdom of Solomon to answer this question.
A young man who is believed to have a rapidly growing malignancy may be advised that a radical prostatectomy is the best chance for survival. For others, external radiation, implanting radium seeds in the prostate gland, or freezing the prostate by cryosurgery are better options. But at the moment, there’s no one ultimate treatment that is the best for everyone.
Three. The late Dr. Willett Whitmore, a world authority on prostate cancer at Memorial Hospital in New York City, remarked, “The survival rate has little to do with treatment. Rather it’s related to the biological nature of the cancer.”
In other words, how malignant is the cancer? So pathologists try to grade cancers by how fast they grow. But it’s still an inexact science. This presents the great dilemma: how to treat or even not to treat prostate cancer.
Four. Hippocrates, the father of medicine, always stressed when treating the patient, “First, do no harm.” This is a huge problem facing doctors who treat patients with prostate cancer.
Five. Suppose you’re about 70 years old and diagnosed with prostate cancer. It’s sometimes better to live with the devil you know than the one you’ve never met. The devil you know may be a slow-growing malignancy and not destined to end your life for many years.
In the meantime, there’s a good chance you will die of something else. By age 70, autopsies show that about 50 percent of males have microscopic cancer cells in their prostate glands. So remember what a world-famous urologist once remarked, “Growing older is invariably fatal, cancer of the prostate, only sometimes.”
Six. The devil you don’t know may be horrible complications resulting from treatment, such as impotence or urinary incontinence. Radical prostatectomy is the most frequent cause. Studies show that urinary incontinence is often under-reported because the person who wets his pants is much more aware of and embarrassed by the annoyance than the surgeon who operated.
Many patients who have contacted me over the years mention how difficult it is to live with this problem and would have refused the surgery if they had known of this possible complication.
Seven. Another wise sage said, “If you’re not confused about prostate cancer, you don’t know what’s going on.” So my advice is to try as much as possible to be informed about this disease before submitting to treatment. Like Benjamin Disraeli, cast a wary eye at statistics.
One of Harvard’s most distinguished professors often stated, “If something has to be proven by statistics, it’s usually wrong.” I say amen to that.
Dr. Gifford-Jones is a medical journalist with a private medical practice in Toronto.
His Web site is Mydoctor.ca/gifford-jones
